Tics are involuntary, sudden, rapid, repetitive, non-rhythmic, stereotyped movements or phonic productions (Lancet Neurol. 2005; 4:149-159). Patients usually are aware of nearly irresistible somatosensory urges that precede the tics. These urges likely reflect a defect in sensorimotor gating because they intrude into the child's conscious awareness and become a source of distraction and distress (J Child Neurol. 2006; 21:642-629). Motor tics range from brief, meaningless motor fragments involving one muscle group (i.e. simple tics) to a more coordinated sequence of movements that last longer and appear as a non-purposeful or more goal-directed action (i.e. complex tics). A diagnosis of chronic tic disorder is made for those with either motor or phonic tics, but not both, continuously or intermittently for more than one year (Semin Pediatr Neurol. 2006; 13:231-242). Several lines of evidence support an abnormality of dopaminergic system in Tourette's syndrome, an idiopathic illness with multiple motor and at least one vocal tics, lasting for at least 1 year before age 21, including the therapeutic response of neuroleptics and the morphological data from postmortem and nuclear imaging studies (Pediatric Neurology: Principles and Practice, 4th ed. Philadelphia, Pa.: Mosby-Elesevier; 2006:887-903; and Brain Dev. 2003; 25:S70-S84). Clinically, dopamine D2-receptor blockers and dopamine depletors are thought to be the most effective anti-tic treatment (Expert Opin Emerg Drugs. 2005; 10:365-380). However, these treatments are suboptimal in terms of effectiveness and side effects, such as body weight gain, extrapyramidal symptoms and exacerbations of anxiety (J Child Neurol. 2006; 21:690-700). In addition to typical neuroleptics, several pharmacological interventions have also been proposed, including atypical neuroleptics, α2-agonists, central nervous system stimulants, selective serotonin reuptake inhibitors, opiates, benzodiazepines, and nicotine. Conversely, dopamine agonists sometimes improve tics or Tourette's syndrome.
Clerodendrum sp. is a shrub belonging to Verbenaceae and widely distributed in South and Southeast Asia, Australia and Pacific islands. The root and leaf extracts of the plants such as Clerodendrum inerme have been reported to be used as a folk medicine in the treatment of various diseases such as coughs, serofulous infection, pyretic, buboes problem, venereal infections and skin disease and beriberi disease, and also as a vermifuge (Phytochemistry. 2001; 58:333-336). However, no scientific literatures or reports indicate that this local herb is useful in relieving symptoms of neurological or psychiatric disorders such as sensorimotor gating deficits or tic attacks.